Risk Factors of Eighth Grader Participants in the “Choking Game”: Results from an Oregon Population-Based Survey

Introduction: The "choking game" is an activity in which persons strangulate themselves to achieve (non-erotic) euphoria through brief hypoxia. The activity can cause long-term disability and death. To assess the awareness and prevalence of this behavior among 8th graders in Oregon, the Oregon Public Health Division asks about familiarity with and participation in this activity in the Oregon Healthy Teens (YRBS) survey.

Methods: Data were obtained from the 2009 Oregon Healthy Teens survey (OHT), a cross-sectional weighted survey of 5,348 8th graders. The survey also included questions on physical health; mental health; gambling; sexual activity; nutrition; physical activity/body image; exposure to violence; and substance use.

Results: Lifetime prevalence of choking game participation was 6.1% for Oregon 8th graders, with no differences between males and females. Among males, black youth were more likely to participate than white youth. Pacific Islander males and females were much more likely to participate than white youth. Of those 8th graders who ever participated, 64% had participated more than once and 26.6% participated more than five times. Multivariate logistic regression revealed that sexual activity and substance use were significantly associated with choking game participation for both males and females.

Conclusions: Eighth graders with sexual activity and/or substance use should be screened for the choking game. The comprehensive adolescent well visit, as recommended by the American Academy of Pediatrics, is a good vehicle for providers to consider a risk assessment and prevention messaging about the potential dangers of this activity.